Giant Cell Tumor of Rib Arising Anteriorly as a Large Inframammary Mass: A Case Report and Review of the Literature

Abstract

Introduction. Giant cell tumor of the bone is a rare benign lesion that infrequently affects the ribs, and if present, is usually located posteriorly. The rarity of this tumor poses diagnostic and therapeutic problems for physicians, especially when it is located in the anterior arc of the rib in close proximity to the breasts in female patients. Case Presentation. We report the case of a 32-year-old Asian female with a giant cell tumor of her anterior rib, presenting as a large inframammary mass. Computed tomography showed a tumor arising from the 7th rib anteriorly with marginal sclerosis, cortical destruction, and a soft tissue mass. She was treated with surgical resection, and the defect was reconstructed primarily. The surgical specimen measured 28.0 × 24.0 cm. The microscopic examination showed a large number of multinucleate giant cells scattered over the parenchyma. Patient recovered uneventfully and continues to be recurrence-free six years after surgical resection. Conclusion. We report the largest known case of giant cell tumor arising from the anterior aspect of a rib. We recommend including giant cell tumor in the differential diagnosis of chest wall masses especially in female patients, regardless of the size on clinical examination.

Giant cell tumour of the rib: an unusual location for an impressive tumour

“…GCTs of bone are uncommon, accounting for only 4–5% of primary bone tumours . The most common sites affected are the metaphyseal plates of long bones, with only 0.6% of all GCTs arising from the ribs . Of GTCs reported in ribs, the majority occur in the posterior arc of the rib and tend to grow internally .…”

“…The most common sites affected are the metaphyseal plates of long bones, with only 0.6% of all GCTs arising from the ribs . Of GTCs reported in ribs, the majority occur in the posterior arc of the rib and tend to grow internally . There are a few reports of anterior GCTs of ribs and can easily be confused with diseases of the breast and even thymus .…”

“…There are a few reports of anterior GCTs of ribs and can easily be confused with diseases of the breast and even thymus . Histologically, GCTs are well vascularized and composed of plump, spindled cells with numerous multinucleated cells . However, it can be difficult to distinguish these tumours histologically from other bone neoplasms such as osteosarcomas, as such diagnosis can rarely be made with fine needle aspiration…”

“…GCTs are considered to be primarily benign but they can be locally invasive . There have been reports of GCTs developing malignant potential through sarcomatous transformation of a benign lesion (approximately 4%) but de novo malignant GCTs can also occur . Pulmonary metastases occur in up to 5% of patients affected but are often felt to be benign .…”

“…Where extensive soft tissue resection is required, pedicled or free myocutaneous flaps are used to correct to deficit . Unfortunately, there is little role for adjuvant therapy, and radiotherapy is best avoided to prevent malignant transformation . Appropriate management of rib‐based GCTs, and other large bony masses, often requires a multidisciplinary approach to obtain the correct diagnosis, adequate surgical resection and reconstruction to minimize chance of recurrence and to ensure full functional recovery.…”